Mitochondrial diseases are heterogeneous genetic disorders caused by respiratory chain (RC) impairment. Attempts to treat mitochondrial diseases have been disappointing so far, mostly due to the lack of defined targets. The leading hypothesis of this application is that mitochondrial disease pathogenesis involves the blockage of crucial steps of the inter-organ amino acid metabolism. We have identified previously unrecognized defects in glutamine metabolism in cells harboring mitochondrial DNA mutations associated with human mitochondrial diseases. We found that the energetic utilization of glutamine through the glutamine-glutamate--ketoglutarate pathway was impaired in these cells. We were able to rescue the metabolic defect by supplementation with compounds that bypass the enzymatic blockages. Glutamine is the most abundant and versatile circulating amino acid, mostly synthesized in skeletal muscle and released in the blood where it plays an important role as a carrier of nitrogen, carbon, and energy between organs. The various glutamine-utilization pathways in the body depend on the specialized metabolism of each tissue and play a crucial role in the inter-organs integrated metabolism that regulates metabolites homeostasis. The goal of this application is to define in vivo the altered glutamine pathways and to bypass the metabolic blockages with dietary supplementation, thus identifying new approaches to the therapy of mitochondrial diseases. To this end, we propose the following aims: 1) Metabolites imbalance in the COX10 KO mouse. We will investigate the glutamine utilization and synthesis pathways in vivo in a mouse model of RC defect caused by genetic disruption of cytochrome c oxidase (COX) assembly, resulting in a progressive mitochondriopathy. The levels of relevant metabolites will be determined in plasma and in tissues, and will be correlated with the bioenergetics, redox, acid/base and nitrogen states. The vulnerability of the affected tissues will be evaluated and correlated with disease progression. 2) Dietary supplementation in the COX10 KO mouse. In preliminary studies in vitro, metabolites that effectively bypass metabolic blocks in RC deficient cells have been identified. These metabolites will be supplemented in the diet of the COX10 KO mouse. The specialized metabolism of different tissues, the inter-organ metabolic homeostasis, and the physiological alterations in relation to disease progression will be assessed. The potential preclinical impact o this aim is that it will provide a rationale for clinical trials based on dietary supplementation, using physiological compounds.